HEALTH PLANS TO CUT PREMIUMS FOR RETIREES.

Byline: Evan Pondel Staff Writer

Health plans are preparing to reduce out-of-pocket costs and premiums for their Medicare members amid recently enacted federal reform legislation that provides additional funds for the industry.

Several health plans throughout California have already announced that Medicare-Plus Choice members, also known as Senior Advantage members, will see a decline in the cost of maintaining their benefits.

Kaiser Permanente, the largest provider of such products in the state, said Los Angeles County Senior Advantage members will see co-payments for doctor visits drop to $10 from $20, while monthly Medicare Part B payments will shed $15. Kaiser also plans to cut premiums for senior members in Ventura County to $40 from $60.

These changes stem from the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The reform law that passed in December essentially increases the amount of federal reimbursement for each Senior Advantage client. The changes are scheduled to go into effect March 1 pending federal approval.

Kaiser, which has approximately 167,000 individual Senior Advantage members, said distributing the additional funds is a challenge. ``It's always hard when you try to figure out how you can benefit the most people,'' said Jim Anderson, a Kaiser spokesman.

Woodland Hills-based Health Net Inc. said more than 65 percent of its Medicare-Plus Choice members will see supplemental premiums either reduced or completely eliminated. The company also plans to cut hospital copayments by more than 40 percent, with almost a quarter of participating seniors likely to gain access to enhanced benefits.

Health Net offers Medicare-Plus Choice HMO and PPO plans to 171,000 members. The company said it will receive an additional 8.8 percent increase in payments from the Centers for Medicare and Medicaid Services when compared with 2003 rates. Health Net would not reveal specific changes to benefits and premium until CMS approved the company's plans.

``But our newly established Senior Products Division is already looking at opportunities to re-enter certain counties and expand our participation in other counties,'' Jay Gellert, Health Net's president and chief executive officer, said in a statement.

Blue Cross of California, with just over 50,000 Medicare-Plus Choice members, is also planning to reduce premiums and copayments for hospitals and specialty services. Spokesman Michael Chee said members of the Thousand Oaks-based company will soon receive notices about the changes, but he would not elaborate about the specifics of those changes.

In line with other health plans, PacifiCare plans to improve prescription drug coverage, decrease copayments and eliminate premiums altogether for its Medicare members. The Cypress-based company, which covers about 350,000 Medicare-Plus Choice members in California, plans to receive a 9.7 percent increase in CMS funding when compared with 2003 rates.

Evan Pondel, [phone]

evan.pondel(at)dailynews.com